儿童扁桃体腺样体低温等离子手术迟发性出血的初步研究

目的 比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发性出血的可能原因.方法 回顾性分析的方法研究采用传统手术和低温等离子手术行扁桃体切除和(或)腺样体刮除术1～14岁患儿术后迟发性出血率及出血时间点的差异.传统组为2005年4月至2006年7月行传统冷法手术(即传统手术刀切除,对周围组织没有热损伤的方法)的患儿,等离子组为2008年4月至2009年9月行低温等离子扁桃体切除和(或)腺样体消融术的患儿.结果 传统组患儿484例,术后迟发性出血2例,迟发性出血率为0.4%,出血时间点1例为术后2 d,另1例为术后3 d.等离子组患儿502例,术后迟发性出血11例,迟发性出血率为2.2%,出血时间点2～12 d,中位数为6.0 d.其中等离子刀初学者主刀手术的迟发性出血率为2.6%(10/385),技术操作熟练者手术的迟发性出血率为0.9%(1/117).等离子组迟发性出血率高于传统组(χ2=5.987,P=0.014),两组出血时间点差异无统计学意义(Mann-Whitney检验U=2.500,P=0.103).13例出血患儿中创面局部或上呼吸道感染者6例,术后进食不当的3例.结论 低温等离子技术应用于儿童扁桃体腺样体手术后迟发性出血的原因可能与手术技能经验不足、止血稳定性欠佳等有关,术后感染和进食不当也会造成迟发性出血,应引起临床重视.     

低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的:探讨低温等离子射频扁桃体部分切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的可行性并观察疗效。方法:回顾性分析91例OSAHS患儿的临床资料,所有患儿无反复咽痛及扁桃体炎表现,主要阻塞病变为扁桃体及腺样体肥大,应用低温等离子射频行扁桃体部分切除术及腺样体消融术治疗。结果:术中出血1～2ml,无原发及继发性出血,术后疼痛轻微。随访12～22个月,所有患儿睡眠打鼾及张口呼吸均消失,无扁桃体再生及反复炎症发作。结论:低温等离子射频切除部分扁桃体治疗儿童OSAHS微创、安全、有效,适用于各年龄段的扁桃体为增生肥大病变的患儿,是一种较好的儿童OSAHS治疗方法。     

低温等离子射频消融治疗小儿鼾症的临床分析

目的：探讨低温等离子射频消融切除扁桃体及腺样体在治疗小儿鼾症中的临床疗效。方法将54例小儿鼾症患者随机分为实验组与对照组,实验组用低温等离子射频消融刀同时切除扁桃体及腺样体,对照组用电凝刀切除扁桃体的同时用动力切割系统切除腺样体。结果两组患儿均在全麻下行扁桃体及腺样体摘除术,实验组较对照组手术时间短,术中出血量少,术后疼痛轻。术后三月复查两组患儿临床症状均完全缓解。结论低温等离子射频消融是治疗小儿鼾症的有效方法,具有手术时间短、术中出血少、术后疼痛轻等优点,值得临床推广。     

等离子消融术治疗儿童OSAS190例临床观察

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行内镜下低温等离子切除扁桃体及腺样体后效果欠佳的原因、术后出血的原因及改进的方法.方法 回顾性分析2007年6月-2011-6月年为190例实行内镜下低温等离子切除扁桃体及腺样体治疗儿童阻塞性睡眠呼吸暂停低通气综合征的临床资料.结果 疗效评定:治愈152例(80％),显效27例(14.21％),有效9例(4.74％),无效2例,总有效率98.94％.显效及有效的36例中有15例为合并慢性鼻-鼻窦炎患者,有望通过鼻部治疗而治愈;6例出现咽腔出血,其中1例是腺样体出血,5例是扁桃体窝出血.结论 低温等离子切除扁桃体及腺样体治疗儿童阻塞性睡眠呼吸暂停综合征效果肯定,术后疗效欠佳的原因是单一切除扁桃体或者腺样体、手术适应症未选择好,鼻部疾患未治愈,术后出血是创面未彻底止血,可以通过腺样体创面彻底止血、缝合扁桃体窝而避免.     

鼻内镜下低温等离子刀扁桃体部分切除术联合腺样体切除术治疗儿童OSAHS的疗效分析

目的观察鼻内镜下低温等离子刀扁桃体部分切除术联合腺样体切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的疗效。方法 2011年2月~2013年7月收治的96例儿童阻塞性睡眠呼吸暂停低通气综合征患儿随机分成两组。观察组患者于鼻内镜下行低温等离子刀扁桃体部分切除术联合腺样体切除术,对照组采用双侧扁桃体剥离术联合动力切割系统切除腺样体。观察两组术中及术后情况,比较分析两组疗效。结果观察组较对照组手术时间短,术中出血量少,术后疼痛轻。术后6月PSG检测显示2组临床症状均显著缓解。结论鼻内镜下低温等离子刀扁桃体部分切除术联合腺样体切除术是治疗儿童OSAHS的有效方法,值得临床推广。     

儿童扁桃体、腺样体低温等离子切除术后出血的临床研究

目的 探讨应用低温等离子手术或者传统手术方式行儿童扁桃体、腺样体切除术在术后出血方面存在的差异。方法 回顾性分析1597例接受手术治疗的儿童慢性扁桃体炎、腺样体肥大的患者资料,行等离子射频辅助的扁桃体和(或)腺样体切除术者793例(等离子组),行传统扁桃体切除和(或)腺样体者804例(传统组)。比较两组原发性及继发性出血的发生率、出血程度和出血部位的差异。结果 等离子组发生术后出血25例(3.2％),传统组出血19例(2.4％),两组间差异无统计学意义(χ2=3．34,P>0．05);其中等离子组原发性出血9例(1.1％),继发性出血16例(2.0％);传统组原发性出血11例(1.4％),继发性出血8例(1．0％),两者比较差异有统计学意义(χ2=9．45,P<0．01)。两组术后的出血部位经卡方检验,出血程度经Wilcoxon秩和检验,P值均>0．05,差异均无统计学意义。结论 低温等离子辅助行儿童扁桃体、腺样体切除术,在术后出血的发生率、程度、部位三个方面相对于传统的手术方法治疗,二者差异无统计学意义。     

低温等离子刀辅助内镜下儿童扁桃体和腺样体切除术临床效果分析

目的:比较低温等离子刀辅助内镜下切除儿童扁桃体和腺样体(rT+A)和传统剥离法切除扁桃体、刮匙法刮除腺样体(cT+A)的手术效果差异.方法:47例扁桃体肥大伴腺样体肥大的患儿,其中24例采用rT+A术式,23例采用cT+A术式,采用t检验比较两组手术时间、术中出血量、术后疼痛时间和假膜脱落时间的差异.随访患儿手术前后听...     

儿童OSAHS治疗探讨

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的治疗方法。方法手术治疗OSAHS患儿35例,其中双侧扁桃体＋腺样体联合切除24例,单侧扁桃体＋腺样体切除3例,单纯腺样体切除5例,双下鼻甲低温等离子消融＋腺样体切除3例。结果35例患儿术后症状消失者27例,症状明显好转6例,有效率94．3％。症状复发2例,其中单侧扁桃体切除加腺样体切除术1例,传统腺样体切刮除后残留1例,2例复发者均再次手术治疗后症状消失。术后3～6个月,对17例患儿复查AHI、最低血氧饱和度,与术前比较有明显改善（P〈0．05）。结论单侧扁桃体切除和单纯腺样体切除术因咽腔扩大不够,疗效欠理想。手术切除肥大腺样体和双侧扁桃体为治疗儿童OSAHS的有效方法。     

探讨低温等离子技术在儿童OSAHS手术中的应用价值

目的探讨低温等离子技术在儿童OSAHS的临床应用疗效及并发症。方法选择2017年3月～2018年2月行手术治疗的89例OSAHS患儿,随机数字法分为观察组和对照组。观察组51例,用低温等离子刀行扁桃体切除术及腺样体消融术。对照组38例,行常规扁桃体切除术及腺样体切除术。对比观察两组患儿治疗有效率、手术持续时间、术中出血量,术后再出血率。结果观察组有效率为98.04%,对照组有效率为84.21%,差异有统计学意义(P=0.039),观察组有效率高于对照组。在手术时间、术中出血量等方面,低温等离子手术组均优于常规手术组。观察组无术后出血病例,再出血率为0.00%;对照组有4例术后出血,再出血率为10.53%,差异有统计学意义(P=0.030),观察组术后出血率低于对照组。结论低温等离子技术在儿童OSAHS手术中,具有疗效好、术中出血量少、手术时间短,术后再出血率低等优点,值得在临床中广泛推广应用。     

儿童扁桃体腺样体低温等离子射频消融术后出血特点分析及应对策略

目的　探讨低温等离子射频消融和传统手术行儿童扁桃体腺样体切除术在术后出血方面存在的差异特点,并提出应对策略。方法　选取2014年于我科行扁桃体腺样体射频消融术999例为等离子组,2010年于我科行扁桃体腺样体切除术1275例为传统组。比较两组总出血率、原发性及继发性出血的发生率、出血部位、出血程度和治疗方法的差异。结果　等离子组术后总出血率、出血部位分布、出血程度和治疗方法分布上与传统组相比差异无统计学意义。等离子组术后原发性出血少于传统组,而继发性出血多于传统组,差异有统计学意义。结论　等离子手术与传统手术相比并不增加术后出血几率,在出血部位分布、治疗方法分布上亦无明显差别;但术后原发性出血减少,而继发性出血升高,分析等离子手术后出血的常见原因,并针对性提出应对策略     

三种手术方式在改良悬雍垂腭咽成形术中的疗效对比

目的 探讨应用超声刀、低温等离子刀以及传统方法进行改良悬雍垂腭咽成形术(H-UPPP)治疗阻塞性睡眠呼吸暂停综合征(OSAHS)的不同效果,并加以分析。方法 将需行H-UPPP的OSAHS患者分成超声刀组(A组)、低温等离子刀组(B组) 及传统组(C组),各42例。在静吸复合麻醉插管下,A组应用超声刀,B组应用改良低温等离子刀,C组应用传统方法,行改良悬雍垂腭咽成形术。对比三组患者的术中出血量、手术时间、术后疼痛程度、术后效果以及并发症的情况。结果 A、B组术中出血量明显少于C组,手术时间缩短明显,术后疼痛较轻,术后并发症及手术效果差异无统计学意义。结论 超声刀、低温等离子刀辅助下悬雍垂腭咽成形术术中出血少、手术时间缩短、术后反应小,其中低温等离子刀术后反应更小。     

Post-tonsillectomy and adenoidectomy hemorrhage

This is a retrospective review of 6842 tonsillectomies and adenoidectomies performed over a seven-year period at the Montreal Children's Hospital. The total incidence of postoperative bleeding was 2.5%. The incidence of primary post-tonsillectomy hemorrhage was 1.0%, with 78% of these children having developed bleeding within 12 hours of surgery. The overall incidence of secondary post-tonsillectomy hemorrhage was 1.2%. Twenty-nine percent of children with primary hemorrhage required a second general anesthetic, and 40% required blood component transfusion. Eight percent of children with secondary hemorrhage required a second general anesthetic and 24% received transfusions. Based on these findings, primary and secondary hemorrhage can be classified further into major and minor. The criteria for a major post-tonsillectomy hemorrhage are: requirements of a general anesthetic to control and repair the bleeding, or blood loss that is sufficient to require blood component transfusion therapy. The relevance of these findings with regard to outpatient adenotonsillectomies is discussed.     

Pediatric adenoidectomy and tonsillectomy--personal viewpoints.

A report on experience with adenoidectomies, tonsillectomies, and adenotonsillectomies carried out at the Hospital for Sick Children, Toronto in the period 1968-75. Operations were performed on 25,443 patients during this period. Reasons for the reduction in T&A operations in recent years are considered, and views are expressed regarding when such operations are indicated, age of patient for surgery, the allergic child, cleft palate patient, the presence of quinsy, cardiopulmonary changes, subluxation of cervical spines, anesthesia, and postoperative care and complications.     

Periodic fever and pharyngitis in young children: a new disease for the otolaryngologist?

OBJECTIVE: A clinical entity consisting of periodic fever associated with aphthous stomatitis, pharyngitis and cervical adenitis termed "PFAPA syndrome" in young children (<5 years old) may be unfamiliar to otolaryngologists. We present our 5-year experience of PFAPA syndrome. DESIGN: Case series. SETTING: Tertiary academic. PATIENTS: A 5-year retrospective chart review for children (<5 years old) who have undergone tonsillectomies with and without adenoidectomies was conducted. Medical records from subjects who underwent the procedures for recurrent pharyngitis were reviewed with reference to a history of periodic fever and stomatitis associated with pharyngitis. INTERVENTIONS: Tonsillectomy with and without adenoidectomy. MAIN OUTCOME MEASURE: The objective measure was a comparison of the number of visits to the primary care physician for pharyngitis associated with fever in a 3-month period before and after the surgical intervention. The subjective measure was a telephone interview evaluating preoperative and postoperative symptoms. RESULTS: Of the 117 patients identified, 22 (19%) underwent surgery for recurrent pharyngitis. Five subjects (average age, 2.5 years) were identified as having PFAPA syndrome. The average number of preoperative PFAPA-related complaints was 11.6 compared with 0.2 for the number of postoperative PFAPA-related complaints (P=.03). CONCLUSIONS: Our experience suggests that PFAPA syndrome is an uncommon disease. Most of these children have undergone workup(s) for sepsis performed by their pediatricians because of the associated high fever. The clinical history of this cohort was quite distinctive. This small sample suggests a significant decrease if not cessation of pharyngitis following surgical intervention.     

Ambulatory adenotonsillectomy in children less than 5 years of age.

OBJECTIVE: Post-tonsillectomy monitoring has received a significant amount of attention in recent years. Although the literature questions the safety of ambulatory adenotonsillectomy in children less than 5 years of age, age alone did not exclude eligibility for day surgery at our institution. METHOD: A retrospective chart review was performed between 1995 and 1998 for all children who had undergone adenoidectomy or adenotonsillectomy at the London Health Sciences Centre in London, ON. RESULTS: There were 119 adenoidectomies and 278 adenotonsillectomies performed. The average age was 3 years at the time of surgery. One hundred and ninety-six cases were performed for obstruction, and 201 were done for infection. Average time spent in the postanaesthesia care unit was 6 hours for adenotonsillectomy and 4.5 hours for adenoidectomy. There were 26 planned and 60 unplanned admissions. One (4/397) percent of the unplanned admissions were for postoperative hemorrhage; 14% (56/397) were for vomiting and dehydration. No cases were admitted for postoperative desaturations or hypotensive episodes. The readmission rate was 0%. CONCLUSIONS: Ambulatory adenotonsillectomy is a safe procedure in children less than 5 years old. However, a well-informed, reliable caretaker and support from the day surgery staff is essential in early discharge of young patients after adenotonsillectomy.     

Lethal post-tonsillectomy hemorrhage

Background: Post-tonsillectomy hemorrhage (PTH) seems to be a rare but unavoidable complication. Due to the frequency of performed tonsillectomies, it can be estimated that a certain amount may result in a lethal outcome. This study was undertaken to evaluate the clinical features of these rare cases. Material and methods: Retrospective case series of five patients with lethal post-tonsillectomy hemorrhage are reported after they had undergone tonsillectomy by four different surgeons. The relevant literature was reviewed. Results: The youngest patient was 42 months and the oldest almost 13 years old. All patients were male. Three patients had left the hospital against surgeon’s recommendation 5 days following tonsillectomy. Preceding episodes of bleeding prior to the lethal bleeding occurred in two patients. Lethal PTH occurred in four patients within 5–9 days, the latest bleeding 39 days after surgery. In the literature, lethal PTH was described for eight patients since 1958. The youngest patient was 4 years, the oldest 18 years old (mean: 8.6 years; median: 6.5 years). In three patients, lethal PTH occurred on the day of surgery and the latest bleeding 54 days after surgery. Conclusion: Due to the paucity of reports, little reliable information can be obtained from the literature. It remains unclear, whether or not this reflects the true incidence of this complication. The experience with the five reported cases suggests, that immediate surgical treatment may have avoided lethal outcome in most cases. Therefore, a close postoperative follow-up is advisable to detect any episode of bleeding as soon as possible which should be referred to a specialist. Certainly, the collected data do not suffice to establish general guidelines, indicating that further collection of cases is required to assess characteristics of lethal PTH.     

Trend changes in the adenotonsillar surgery

In order to evaluate possible trend changes in the epidemiological factors of adenotonsillar surgery, a total of 1,958 operations performed between 1992 and 2002 were reviewed. RESULTS: One third of the operations were to remove tonsils in comparison with the two thirds that were to remove adenoids. Three procedures were used: 59% adenoidectomies, 28% adenotonsillectomies and 13% tonsillectomies. During the study period, the percentage of adenotonsillectomies decreased, whereas the number of adenoidectomies increased. In general, this kind of surgery is mainly performed on males. CONCLUSIONS: Although we have not discovered variations regarding gender and average age for the operations, adenotonsillar surgery has increased over recent years and the percentage ratio of the various procedures has altered as a result of new indications.     

Tonsillektomie mit dem ultraschallaktivierten Skalpell Erste Ergebnisse zur Technik mit dem Ultracision Harmonic Scalpel®

BACKGROUND: Tonsillectomy requires an efficient intra- and postoperative hemostasis. The ultrasonically activated scalpel (UAS) uses high-frequency ultrasonic energy to perform tissue dissection and coagulation simultaneously. The present prospective study represents the first published results of UAS in tonsillectomy. METHOD: 60 patients with tonsillectomy were examined in regard of intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histopathological specimen was evaluated. RESULTS: In 90% of tonsillectomies by UAS efficient intraoperative hemostasis did not require suture ligature. In 10% additional ligation was required for reason of arterial bleeding. Postoperative bleeding did not occur at all, wound healing was uneventful. Surgery related postoperative pain was not intensified. The histopathological evaluation of specimen was not impaired. CONCLUSION: The UAS offers a tissue dissection with efficacious intra- and postoperative hemostasis. Compared to the conventional tonsillectomy the ultrasonical technique of tonsillectomy has especially in children, in anaemic patients and in the surgery of tonsillar malignomas significant advantages.     

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy

CONCLUSION: There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. OBJECTIVE: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. MATERIAL AND METHODS: All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years). RESULTS: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of "selected" elective tonsillectomies. The difference between these two rates was not significant (p = 0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.     

Post-tonsillectomy haemorrhage: A retrospective comparison of abscess- and elective tonsillectomy

Conclusion. There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. Objective. There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. Material and methods. All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3–88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2–83 years). Results. In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1–4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2–8.6%) in the age- and gender-matched group of “selected” elective tonsillectomies. The difference between these two rates was not significant (p=0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.